Multigen Plus Tablets
WARNING: Accidental overdose of drugs that have iron in them is a leading cause of deadly poisoning in children younger than 6 years of age. Keep away from children. If this drug is taken by accident, call a doctor or poison control center right away. @ COMMON USES: It is used to treat or prevent low iron in the body.It is used to help growth and good health.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Nutritional Supplement; Hematinic
Pharmacologic Class
Multivitamin/Mineral Supplement; Iron Preparations; B Vitamins
Pregnancy Category
Not available
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
Multigen Plus Tablets are a combination of essential vitamins and minerals, primarily iron, vitamin C, folic acid, and vitamin B12, along with succinic acid. It's used to prevent or treat deficiencies of these nutrients, especially iron deficiency anemia, and to support overall health, particularly red blood cell formation.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from this medication, take it exactly as directed by your doctor. Carefully read all the information provided with your prescription, and follow the instructions closely. For optimal effectiveness, take this medication on an empty stomach. However, if it causes stomach upset, you may take it with food. Certain foods, such as eggs, whole grain bread, cereal, dairy products, coffee, and tea, may interfere with the medication's absorption. If you experience stomach upset, consult your doctor for guidance on taking the medication with food.
It's essential to note that this medication can interact with other drugs, preventing them from being absorbed properly. If you're taking other medications, consult your doctor or pharmacist to determine if you should take them at a different time than this medication.
Storing and Disposing of Your Medication
To maintain the medication's potency, store it at room temperature, protected from light, and in a dry place. Avoid storing it in a bathroom. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. If you're unsure about the best way to dispose of your medication, consult your pharmacist. You may also want to explore drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
To get the most benefit from this medication, take it exactly as directed by your doctor. Carefully read all the information provided with your prescription, and follow the instructions closely. For optimal effectiveness, take this medication on an empty stomach. However, if it causes stomach upset, you may take it with food. Certain foods, such as eggs, whole grain bread, cereal, dairy products, coffee, and tea, may interfere with the medication's absorption. If you experience stomach upset, consult your doctor for guidance on taking the medication with food.
It's essential to note that this medication can interact with other drugs, preventing them from being absorbed properly. If you're taking other medications, consult your doctor or pharmacist to determine if you should take them at a different time than this medication.
Storing and Disposing of Your Medication
To maintain the medication's potency, store it at room temperature, protected from light, and in a dry place. Avoid storing it in a bathroom. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. If you're unsure about the best way to dispose of your medication, consult your pharmacist. You may also want to explore drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
Lifestyle & Tips
- Take with food if stomach upset occurs, but be aware that some foods (like dairy, tea, coffee) can reduce iron absorption. Vitamin C in the tablet helps with iron absorption.
- Do not take with antacids, calcium supplements, or certain antibiotics (tetracyclines, quinolones) at the same time. Separate doses by at least 2-4 hours.
- Drink plenty of fluids and eat fiber-rich foods to help prevent constipation, a common side effect of iron.
- Stools may appear dark or black; this is a normal and harmless effect of iron supplementation.
- Store in a cool, dry place, out of reach of children. Iron overdose can be fatal in young children.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Standard Dose:
1 tablet orally once daily, preferably with a meal
Dose Range:
1 - 2 mg
Condition-Specific Dosing:
iron_deficiency_anemia:
May be increased to 2 tablets daily, or as directed by a healthcare professional, based on severity and individual needs.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established, consult pediatrician for appropriate dosing of individual components if needed.
Adolescent:
Typically adult dosing for ages 12 and above, but consult pediatrician.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment generally needed, but monitor iron levels if significant impairment.
Moderate:
Use with caution; monitor iron levels. Avoid if risk of iron accumulation.
Severe:
Use with caution; monitor iron levels closely. Avoid if risk of iron accumulation or hemochromatosis.
Dialysis:
Consult nephrologist; iron supplementation may be managed differently in dialysis patients.
Hepatic Impairment:
Mild:
No specific adjustment generally needed.
Moderate:
Use with caution; monitor iron levels. Avoid if risk of iron overload (e.g., hemochromatosis, sideroblastic anemia).
Severe:
Contraindicated in conditions with iron overload (e.g., hemochromatosis). Use with extreme caution; monitor iron levels closely.
Confidence:
Medium
Pharmacology
Mechanism of Action
Multigen Plus Tablets provide essential micronutrients. Iron is crucial for hemoglobin synthesis and oxygen transport. Succinic Acid is a Krebs cycle intermediate, potentially aiding cellular respiration and iron utilization, though its direct role in iron absorption enhancement in this context is less defined than Vitamin C. Vitamin C (Ascorbic Acid) enhances the absorption of non-heme iron by reducing ferric iron (Fe3+) to ferrous iron (Fe2+), which is more readily absorbed. Folic Acid (Vitamin B9) and Vitamin B12 (Cobalamin) are coenzymes essential for DNA synthesis, cell division, and red blood cell maturation. They are critical for erythropoiesis and neurological function.
Pharmacokinetics
Absorption:
Bioavailability:
Iron: 10-30% (non-heme, highly variable, increased by Vitamin C). Succinic Acid: Readily absorbed. Vitamin C: Dose-dependent, 70-90% at low doses, decreases with higher doses. Folic Acid: Nearly 100% from supplements. Vitamin B12: 1-5% orally, requires intrinsic factor.
Tmax:
Iron: 2-4 hours. Vitamin C: 2-3 hours. Folic Acid: 1 hour. Vitamin B12: 8-12 hours.
FoodEffect:
Iron absorption is decreased by food (especially dairy, tea, coffee, whole grains) but taking with food can reduce GI upset. Vitamin C absorption is not significantly affected by food. Folic Acid and Vitamin B12 absorption are generally not significantly affected by food, though B12 requires intrinsic factor which is produced in the stomach.
Distribution:
Vd:
Iron: Distributed throughout the body, primarily bound to transferrin. Vitamin C: Distributed widely in body tissues. Folic Acid: Distributed widely, stored in liver. Vitamin B12: Stored primarily in the liver.
ProteinBinding:
Iron: >90% bound to transferrin. Vitamin C: Low protein binding. Folic Acid: Highly protein bound. Vitamin B12: Highly bound to transcobalamins.
CnssPenetration:
Iron: Limited. Vitamin C: Yes. Folic Acid: Yes. Vitamin B12: Yes.
Elimination:
HalfLife:
Iron: Not applicable (incorporated). Vitamin C: 8-40 hours (dose-dependent). Folic Acid: 30-60 minutes (for unmetabolized folic acid). Vitamin B12: ~6 days (body stores last for years).
Clearance:
Not applicable for iron. Vitamin C: Renal clearance. Folic Acid: Renal clearance. Vitamin B12: Renal clearance of unbound forms.
ExcretionRoute:
Iron: Primarily fecal (unabsorbed), minimal renal. Vitamin C: Renal (unchanged or as metabolites). Folic Acid: Renal (unchanged or as metabolites). Vitamin B12: Renal (small amounts), enterohepatic recirculation.
Unchanged:
Iron: Not applicable. Vitamin C: Significant portion excreted unchanged at high doses. Folic Acid: Small amount. Vitamin B12: Small amount.
Pharmacodynamics
OnsetOfAction:
Nutritional effects are gradual. For iron deficiency anemia, improvement in symptoms and blood counts typically seen within weeks to months.
PeakEffect:
Clinical improvement for deficiency states is gradual, over weeks to months.
DurationOfAction:
As long as supplementation continues and stores are maintained.
Confidence:
Medium
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Attention Immediately
While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical help right away:
- Signs of an allergic reaction, such as rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat
- Black, tarry, or bloody stools
- Fever
- Vomiting blood or material that resembles coffee grounds
- Stomach cramps
Other Possible Side Effects
Like all medications, this drug can cause side effects. Although many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms that bother you or do not go away, contact your doctor for advice:
- Constipation
- Diarrhea
- Stomach pain
- Upset stomach
- Vomiting
- Change in stool color to green
Reporting Side Effects
This list does not include all possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical help right away:
- Signs of an allergic reaction, such as rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat
- Black, tarry, or bloody stools
- Fever
- Vomiting blood or material that resembles coffee grounds
- Stomach cramps
Other Possible Side Effects
Like all medications, this drug can cause side effects. Although many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms that bother you or do not go away, contact your doctor for advice:
- Constipation
- Diarrhea
- Stomach pain
- Upset stomach
- Vomiting
- Change in stool color to green
Reporting Side Effects
This list does not include all possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe constipation or diarrhea
- Severe stomach pain or cramps
- Vomiting
- Allergic reaction (rash, itching, swelling, severe dizziness, trouble breathing)
- Signs of iron overload (fatigue, joint pain, abdominal pain, dark skin, heart problems) - rare with typical doses but possible with excessive intake or underlying conditions.
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
If you have an iron overload in your body.
* If you have certain types of anemia, including pernicious anemia or hemolytic anemia.
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health issues with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions.
Remember, do not start, stop, or adjust the dosage of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
If you have an iron overload in your body.
* If you have certain types of anemia, including pernicious anemia or hemolytic anemia.
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health issues with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions.
Remember, do not start, stop, or adjust the dosage of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. If you have a soy allergy, discuss this with your doctor, as some formulations of this drug may contain soy.
Additionally, be aware that this medication may interfere with certain laboratory tests. Therefore, it is crucial to notify all your healthcare providers and laboratory personnel that you are taking this drug.
If you are allergic to tartrazine, also known as FD&C Yellow No. 5, consult with your doctor, as some products may contain this ingredient.
Before taking this medication, inform your doctor if you are pregnant, planning to become pregnant, or are breastfeeding. Your doctor will need to discuss the potential benefits and risks of this medication to both you and your baby.
Additionally, be aware that this medication may interfere with certain laboratory tests. Therefore, it is crucial to notify all your healthcare providers and laboratory personnel that you are taking this drug.
If you are allergic to tartrazine, also known as FD&C Yellow No. 5, consult with your doctor, as some products may contain this ingredient.
Before taking this medication, inform your doctor if you are pregnant, planning to become pregnant, or are breastfeeding. Your doctor will need to discuss the potential benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Severe stomach pain
- Nausea
- Vomiting (may contain blood)
- Diarrhea
- Bloody stools
- Drowsiness
- Pale, clammy skin
- Rapid, shallow breathing
- Weak, rapid pulse
- Low blood pressure
- Seizures
- Coma
- Liver damage (delayed)
What to Do:
Seek immediate medical attention. Call 911 or Poison Control at 1-800-222-1222. Iron overdose is a medical emergency, especially in children.
Drug Interactions
Major Interactions
- Iron with Dimercaprol: Increased nephrotoxicity.
- Folic Acid with Methotrexate: Folic acid can reduce the efficacy of methotrexate (a folate antagonist).
- Folic Acid with Phenytoin/Fosphenytoin: Folic acid can decrease phenytoin levels, potentially leading to seizures. Phenytoin can decrease folate levels.
Moderate Interactions
- Iron with Tetracyclines/Doxycycline: Iron can chelate tetracyclines, reducing absorption of both. Separate administration by 2-3 hours.
- Iron with Quinolone Antibiotics (e.g., Ciprofloxacin, Levofloxacin): Iron can chelate quinolones, reducing absorption. Separate administration by 2-6 hours.
- Iron with Levothyroxine: Iron can impair levothyroxine absorption. Separate administration by at least 4 hours.
- Iron with Antacids/PPIs/H2 Blockers: Reduced iron absorption due to increased gastric pH. Separate administration by 2-4 hours.
- Iron with Mycophenolate Mofetil: Iron can decrease mycophenolate absorption.
- Vitamin C with Deferoxamine: Increased iron toxicity (cardiac dysfunction) in patients with iron overload. Avoid concomitant use.
- Vitamin B12 with Metformin: Metformin can reduce Vitamin B12 absorption.
- Folic Acid with Pyrimethamine: Folic acid can reduce the efficacy of pyrimethamine (a folate antagonist).
Minor Interactions
- Iron with Calcium supplements: May slightly reduce iron absorption. Separate administration if possible.
- Iron with Zinc supplements: High doses of iron can interfere with zinc absorption.
- Vitamin C with Oral Contraceptives: May slightly increase estrogen levels.
- Vitamin C with Warfarin: High doses of Vitamin C may theoretically alter warfarin effects, though clinical significance is low.
Monitoring
Baseline Monitoring
Complete Blood Count (CBC) with differential
Rationale: To assess baseline hemoglobin, hematocrit, and red blood cell indices (MCV, MCH) to confirm anemia and characterize its type.
Timing: Prior to initiation, especially if treating deficiency.
Serum Ferritin, Serum Iron, Total Iron Binding Capacity (TIBC)
Rationale: To assess iron stores and confirm iron deficiency.
Timing: Prior to initiation, especially if treating deficiency.
Serum Folic Acid and Vitamin B12 levels
Rationale: To assess baseline levels and confirm deficiency if suspected.
Timing: Prior to initiation, especially if treating deficiency.
Routine Monitoring
Complete Blood Count (CBC)
Frequency: Every 1-3 months initially, then every 3-6 months once stable, if treating deficiency.
Target: Hemoglobin: Age and sex-specific normal ranges; MCV: 80-100 fL
Action Threshold: Failure of hemoglobin to rise, or continued symptoms of anemia.
Serum Ferritin
Frequency: Every 3-6 months, or as clinically indicated, if treating iron deficiency.
Target: >30-50 ng/mL (to replenish stores)
Action Threshold: Levels not increasing or remaining low despite adherence.
Serum Folic Acid and Vitamin B12 levels
Frequency: Every 6-12 months, or as clinically indicated, if treating deficiency.
Target: Folic Acid: >4 ng/mL; Vitamin B12: >200 pg/mL
Action Threshold: Levels remaining low or symptoms of deficiency persisting.
Gastrointestinal symptoms (constipation, nausea, abdominal pain)
Frequency: Daily, especially during initial therapy.
Target: Minimal to no symptoms
Action Threshold: Persistent or severe symptoms warranting dose adjustment or alternative formulation.
Symptom Monitoring
- Fatigue
- Weakness
- Pallor
- Shortness of breath
- Dizziness
- Headache
- Pica (craving for non-food items)
- Glossitis (sore tongue)
- Peripheral neuropathy (for B12 deficiency)
- Constipation
- Nausea
- Abdominal pain
- Dark stools (expected with iron supplementation)
Special Patient Groups
Pregnancy
Generally considered safe and often recommended during pregnancy to prevent and treat iron deficiency anemia and neural tube defects (due to folic acid). However, specific dosing should be guided by a healthcare professional.
Trimester-Specific Risks:
First Trimester:
Folic acid is crucial in the first trimester to prevent neural tube defects. Iron and B12 are also important for maternal and fetal development.
Second Trimester:
Continued need for iron, folic acid, and B12 as fetal growth accelerates and maternal blood volume expands.
Third Trimester:
Increased demand for iron to support fetal iron stores and prevent maternal anemia.
Lactation
Generally considered safe and beneficial during lactation. Iron, folic acid, and B12 are excreted in breast milk in small amounts and are important for infant development. Dosing should be within recommended limits.
Infant Risk:
L1 (Lowest Risk) for individual components at recommended doses. No known adverse effects on breastfed infants.
Pediatric Use
Use with caution and only under medical supervision. Iron overdose is a leading cause of poisoning fatalities in young children. Dosing must be carefully calculated based on weight and age, and specific pediatric formulations may be more appropriate.
Geriatric Use
Generally safe. Older adults may have increased risk of B12 deficiency (due to reduced intrinsic factor) and iron deficiency. Monitor for potential drug interactions and gastrointestinal side effects (e.g., constipation).
Clinical Information
Clinical Pearls
- Iron absorption is best on an empty stomach, but taking with food can reduce GI upset. The Vitamin C in this formulation helps optimize iron absorption.
- Educate patients that dark or black stools are a normal side effect of iron supplementation and not a cause for alarm, unless accompanied by other symptoms like severe abdominal pain or bloody diarrhea.
- Emphasize the critical importance of keeping iron-containing supplements out of reach of children due to the high risk of fatal overdose.
- For patients with known B12 deficiency, ensure adequate intrinsic factor production or consider alternative routes of B12 administration if absorption is impaired (e.g., pernicious anemia).
- Succinic acid's role in this combination is primarily supportive; the main therapeutic effects come from iron, Vitamin C, Folic Acid, and B12.
Alternative Therapies
- Individual iron supplements (e.g., ferrous sulfate, ferrous gluconate)
- Individual folic acid supplements
- Individual Vitamin B12 supplements (oral, sublingual, injection)
- Dietary modifications to increase intake of iron-rich foods (red meat, fortified cereals), folate (leafy greens), and B12 (animal products).
Cost & Coverage
Average Cost:
$10 - $30 per 30 tablets
Generic Available:
Yes
Insurance Coverage:
Not typically covered by most insurance plans as it is a dietary supplement. May be covered by FSA/HSA.
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it's a good idea to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide details about the overdose, including the medication taken, the amount, and the time it occurred.